The present invention may be applicable to the treatment of biological soft tissue either before or after the damaged biological soft tissue is severed and/or resected. This can be accomplished by the introduction of an implant device of the present invention. The present invention is described with reference to a damaged biceps tendon, but one of skill in the art will recognize that the present invention is not limited to the treatment of biceps tendons, and will also recognize the applicability of the present invention to other biological soft tissues.
Referring initially to FIG. 1A, a frontal view of the normal right human shoulder is illustrated. The biceps tendon 10 is a tendon that joins part of the biceps brachii, (i.e., the biceps muscle) to the shoulder. Specifically, the biceps tendon 10 inserts on the most superior portion of the glenoid labrum of the scapula 12 in the shoulder and extends downwardly to the biceps muscle 16 in the upper arm. The biceps tendon 10 is often referred to as the “long head” of the biceps brachii, ie: the long head of the biceps tendon. As can be further seen in FIG. 1A, the short head 24 of the biceps brachii also functions to attach the biceps muscle 16 to the shoulder. The biceps tendon 10 lies along the bicipital groove 18 in the humerus 20 and passes through a bicipital sheath 22. It is believed that the biceps tendon 10 contributes to stability of the shoulder, particularly when a patient's arm is disposed in certain orientations.
As a patient ages, the biceps tendon may become painful, inflamed, or may degenerate and fray beneath its upper attachment point, the point of attachment at the glenoid cavity. The degeneration and fraying of the biceps tendon is often due to abrasion against adjacent shoulder structures. This can result in tearing and cause the patient significant pain. One method of treating the pain caused by a partially torn biceps tendon 10 is to perform a procedure called a tenotomy. One benefit of a tenotomy is that it can easily be performed arthroscopically. As shown in FIG. 1B, a tenotomy involves severing the biceps tendon 10 at its upper end 26, so that it is detached from the glenoid. This procedure is typically effective at relieving the patient's pain symptoms caused by a degenerative and/or frayed biceps tendon. Despite severing the biceps tendon as part of a tenotomy, it has been found that the remaining structure supporting the biceps muscle 16, including the short head 24, provides adequate anterior stability for the shoulder, especially because the typical tenotomy patient is usually older and less physically active by the time the procedure is required. Since stability can be maintained despite a severed biceps tendon, a frayed and/or degenerative biceps tendon can be severed to alleviate associated pain.
Following a tenotomy procedure, patients often experience undesirable side effects. One of the most common side of these effects is known informally as a “Popeye Sign.” As shown in FIG. 1C, a Popeye Sign develops when the biceps tendon 10 retracts down through the bicipital sheath 22. The retraction of the biceps tendon 10 causes the biceps 16 to sag and bulge in an unsightly way, as shown. The patient must therefore live with the resultant unsightly appearance and may also suffer from muscle cramping or aching. Consequently, this potential side effect is a significant deterrent to undergoing a tenotomy procedure and realizing the benefits of substantial pain relief.
Other approaches have been developed to try to obtain the benefits of pain relief while avoiding the side effect of a “Popeye Sign.” One such approach, known as “biceps tenodesis,” can be performed either by means of open or arthroscopic surgery. When performing a biceps tenodesis, the biceps tendon 10 is severed just as when performing a tenotomy. Unlike the tenotomy, however, in a biceps tenodesis, the biceps tendon 10 is sutured to the humerus 20 within the bicipital groove 18, using suture anchors to prevent the tendon from slipping downwardly through the sheath 22. Such a procedure is described in an article entitled Arthroscopic Biceps Tenodesis Using the Percutaneous Intra-articular Transtendon Technique, by Sekiya et al. published in the December 2003 edition Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol. 19, No. 10 (pp. 1137-1141). While a biceps tenodesis procedure is often successful, if performed using open surgical techniques, as is the present state of the art, it results in an unsightly scar and an extended recovery period when compared to a tenotomy. The arthroscopic procedure described in the identified article avoids the scarring issue, but is complex and difficult for most surgeons to perform using today's instrumentation. Moreover, the arthroscopic procedure still generally requires a longer recovery period than a simple tenotomy.
Thus, it is desirable for surgeons to be able to perform a procedure similar to a simple tenotomy and receive results comparable to those achieved by tenodesis.